Factors associated with the orthopaedic surgeon's decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1905 patients

Research output: Contribution to journalArticle


Objective: To determine factors associated with orthopaedic surgeons’ decision to recommend total joint replacement (TJR) in people with knee and hip osteoarthritis (OA). Design: Cross-sectional study in eleven countries. For consecutive outpatients with definite hip or knee OA consulting an orthopaedic surgeon, the surgeon's indication of TJR was collected, as well as patients’ characteristics including comorbidities and social situation, OA symptom duration, pain, stiffness and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), joint-specific quality of life, Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) radiographic grade (0–4), and surgeons’ characteristics. Univariable and multivariable logistic regressions were performed to identify factors associated with the indication of TJR, adjusted by country. Results: In total, 1905 patients were included: mean age was 66.5 (standard deviation [SD], 10.8) years, 1082 (58.0%) were women, mean OA symptom duration was 5.0 (SD 7.0) years. TJR was recommended in 561/1127 (49.8%) knee OA and 542/778 (69.7%) hip OA patients. In multivariable analysis on 516 patients with complete data, the variables associated with TJR indication were radiographic grade (Odds Ratio, OR for one grade increase, for knee and hip OA, respectively: 2.90, 95% confidence interval [1.69–4.97] and 3.30 [2.17–5.03]) and WOMAC total score (OR for 10 points increase: 1.65 [1.32–2.06] and 1.38 [1.15–1.66], respectively). After excluding radiographic grade from the analyses, on 1265 patients, greater WOMAC total score was the main predictor for knee and hip OA; older age was also significant for knee OA. Conclusion: Radiographic severity and patient-reported pain and function play a major role in surgeons’ recommendation for TJR.


  • C. Huynh
  • D. Puyraimond-Zemmour
  • J. F. Maillefert
  • P. G. Conaghan
  • A. M. Davis
  • Klaus-Peter Gunther
  • G. Hawker
  • M. C. Hochberg
  • M. Kloppenburg
  • K. Lim
  • N. N. Mahomed
  • L. March
  • K. Pavelka
  • L. Punzi
  • E. M. Roos
  • L. Sanchez-Riera
  • J. A. Singh
  • M. E. Suarez-Almazor
  • M. Dougados
  • L. Gossec
External organisations
  • Pierre and Marie Curie University
  • Pitié Salpetriere University Paris
  • Dijon University Hospital
  • University of Burgundy
  • University of Leeds
  • University of Toronto
  • Dresden University of Technology
  • University of Maryland School of Medicine
  • Leiden University Medical Centre
  • University of Melbourne
  • University of Sydney
  • Charles University in Prague
  • University of Padova
  • University of Southern Denmark
  • University of Alabama
  • University of Texas
  • Paris Descartes University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics


  • Hip, Knee, Osteoarthritis, Surgery, Total joint replacement
Original languageEnglish
Pages (from-to)1311-1318
JournalOsteoarthritis and Cartilage
Issue number10
Publication statusPublished - 2018 Jan
Publication categoryResearch